Provider Demographics
NPI:1437121100
Name:COLVETT, KYLE (MD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:COLVETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5099
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-5099
Mailing Address - Country:US
Mailing Address - Phone:423-431-6000
Mailing Address - Fax:423-431-6060
Practice Address - Street 1:400 N STATE OF FRANKLIN RD
Practice Address - Street 2:CANCER TREATMENT CENTER
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6035
Practice Address - Country:US
Practice Address - Phone:423-431-6000
Practice Address - Fax:423-431-6060
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000276212085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3042167OtherBLUE CROSS BLUE SHIELD T
TN3045857OtherBLUE CROSS BS OF TN GROUP
TN3045857OtherBLUE CROSS BS OF TN GROUP
TN3042167OtherBLUE CROSS BLUE SHIELD T
TNG39126Medicare UPIN